1. Field of the Invention
This invention relates to a surgical instrument particularly useful in tonsillar surgeries which greatly facilitates the surgeon's task of dissecting tissue and avoiding excessive bleeding. In particular, this invention relates to a dissector whereby the surgeon can use suction to remove excess fluid and bipolar electrocoagulation without the necessity of changing instruments.
2. Description of the Prior Art
The performance of tonsillectomy and adenotonsillectomy surgical procedures are common throughout the United States and elsewhere, with an estimated 340,000 performed in the United States each year. The major complication of tonsillectomy is post-operative hemorrhage. As the techniques by which tonsils are removed over time have been refined, electrocoagulation has been used more frequently to achieve hemostasis.
Suction electrocoagulation for removal of tonsils is an effective method with minimal blood loss. Blood vessels are electrocoagulated as they are encountered. However, with ordinary coagulation, the trauma to tissues may extend 1 to 2 mm beyond the point of contact. This causes greater tissue necrosis and may lead to late post-operative bleeding. However, suction electrocoagulation devices heretofore presented are not good dissecting instruments. Nonetheless, there is a tendency to use such electrocoagulation devices to cut through adherent tissue which leads to even greater tissue trauma. The other option is to switch back and forth between using a suction electrocoagulation device and a dissecting instrument such as the Fischer "hockey-stick" style dissector. Such switching between instruments prolongs the surgery and the time the patient must remain under anesthetic, permits additional hemorrhaging during instrument changes, and decreases efficiency.
Another method for the removal of tonsils is with a bipolar electrocoagulating forceps. With bipolar electrocoagulation, tissue damage is limited to the tissue between the tines of the bipolar coagulator. A recent study by Dr. Mario Andrea in the October, 1993 edition of Laryngoscope used this technique in 265 patients. The study demonstrated its effectiveness and also negligible delayed post-operative bleeding. The bipolar electrocoagulating forceps is designed principally for coagulation. If suction is needed, which is not uncommon, another instrument must be introduced into the operating field. To some degree, a bipolar coagulator may be used as a dissecting instrument; there are many instances where conventional dissection is more advantageous as dissection is not inherent in the bipolar coagulator's design.
Thus, there has developed a need for a surgical instrument which enables the surgeon to take advantage of the optimum features of dissection, bipolar electrocoagulation, and suction and thereby remove the temptation to make one instrument "do" for another. The techniques of tonsillectomy with the suction electrocoagulation device or with the bipolar electrocoagulation forceps were both developed for a more efficient method with less operative and delayed post-operative bleeding. However, there are drawbacks to both techniques which may be obviated if the functions of bipolar electrocoagulation, suction, and dissection could be combined into one instrument.